T Nation

Knee Tendonitis or Patellofemoral Stress?


#1

Need some help if anyone has experience with this

My knees have been hurting, a LOT lately. It's mostly when I squat. I've been pushing myself pretty hard lately especially with the squatting motions. Rest of my day though I spend a lot of time sitting, so i figure it might have something to do with that as well (gluteal amnesia). Oh and I have (severely) flat feet.

I think I'm going to go by this article and just get some rest from squatting motions...

http://www.elitefts.com/documents/knee_pain.htm

I'll probably stick with pulling motions (which gives me zero pain) for now till the pain is alleviated.

The pain started to arise when i switched to ass to grass squats. I never had this problem with box squats... I think the ROOT of the problem might be my flat feet which would cause my knees to pronate inward, especially when squatting to the deck.
Hell ive spent months doing nothing but front squats and rack pulls and never had this problem.

And though it seems to be symptomatic of a mobility problem, I'm flexible as fuck (i can kick well over my head and nearly do the splits in each direction), so I don't think it's that. And my glutes seem to be firing fine, I can do all of the glute activation drills with no problem, difficulty, or anything.

If it is the flat feet, would squatting with nike free's be what's causing my pronation? Do i need to squat in regular shoes or something with sturdy arch-supports?

Blargh. Help!


#2

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#3

I wouldn’t squat heavy in Frees myself, way too unstable. I much prefer oly shoes, and shifting from high bar to low bar provided relief to the knees. Even if my form doesn’t really look that much different


#4

also do you foam roll and do release work? I’m thinking glutes, glute medius, piniformis, IT band/side of quad etc

helps a bunch of they are tight and knotted up


#5

Some people get relief by focusing on shoving their knees out when they squat. I am a moderate overpronator, and my knees can buckle inward if I don’t think about it. Really exaggerate this shoving out idea. It’s hard to do it right unless you try to overdo it.

Another thing: it may not be worth it for you to squat fully ATG. Try squatting low enough that you go to legal depth, but not so low that you lose tightness anywhere. There may be benefits to going fully ATG, but from what I understand, the benefits aren’t that great compared to just going to legal depth (hip crease below top of knees).


#6

[quote]CoolColJ wrote:
also do you foam roll and do release work? I’m thinking glutes, glute medius, piniformis, IT band/side of quad etc

helps a bunch of they are tight and knotted up[/quote]

I also am a BIG fan of foam rolling for these areas. Have you tried doing a piriformis roll on a baseball with one leg crosse? = awesome.


#7

I might need to start using a baseball, i’ve been using a tennis ball. I’ve started doing it on a more regular basis. I don’t do it nearly as much as I should… I’ve been rectifying that as of late.

Maybe the free’s are what are doing it. I used to squat in my skate shoes. I need to buy some chucks or get my romaleo’s out.

I want to use a2g squats because the additional range of motion is great for my sport (mma). Unfortunately injuring myself is not.


#8

I’d ditch the a2g’s man. I’ve always had a bit of tendonitis in my left knee, but after doing a2g’s exclusively for squatting my knees [both] haven’t been the same. I’ve since switched back, but my #'s aren’t what they were, and this was over a year ago. I also deal with a constant pain that wasn’t there before. Some people just aren’t wired for certain movements.

For me, one of those movements is a2g squats. For what it’s worth I’m having surgery on my right knee on tuesday and an mri on my left exactly one week later, and while I don’t think the deep squats contributed to the right knee problem, they most certainly contributed to the left.


#9

thanks for scary the everloving cheese and crackers out of me lol. Considering how good i am with box squats I don’t know why i ever switched, i’m really regretting it now i can’t fucking train and it’s KILLING me.


#10

I second what others have said.

Over-exaggerate the pushing out of the knees.

Take a break from ATG squatting, and it’ll probably do you some good to take a break from squatting altogether.

Use wraps or sleeves.

I used to get the same pain in my left knee. (I never even thought about it being related to my flat feet, though. Nice observation.) I just stopped squatting for about 2 months and it mostly went away. Now the only time I go ATG is with front squats. When I back squat, which is only once or twice a month, if that, I never go below parallel. Normally I just high-box squat. I go 1-3 inches above parallel.


#11

Sorry to hear bro.

First, use those oly shoes. Unless you are a wide stance squatter, they will probably help a bunch.

Second, at the minimum buy some sleeves and blue heat. I would advise to start wrapping lightly as you get to heavier sets.

Last, work on the foam rolling stuff but I’d also look into someone in your area who can do A.R.T. I have had some knee issues in the past and this helped a fair bit. Good luck!


#12

Make sure your shins are totally vertical throughout the squat and your knee pain will disappear. Do em in a mirror.


#13

I’d also agree with those that say take a rest. You say you’ve been pushing squats hard so your joints may just need a break from the movement.

Does squatting A2G hurt without any weight? If not, perhaps your form is changing with increasing intensity. If it does hurt then check your form from different angles in the mirror to make sure you aren’t having any problems. Flat feet and pronation can cause the knees to come together but I believe it can be corrected. I have pretty bad flat feet and I squat A2G fine. Occasionally I do also feel a little twinge. I just stop and call it a day. Don’t work through knee pain. You’ll just make things worse.

Good luck!


#14

Another vote for “stop atg until your knees stop hurting”.

I stupidly did leg extensions before Xmas and my knees were hurting me for 6 weeks and it’s finally went away. I have still been squatting heavy but only to parallel with focus on keeping my knees out (often I use a mini band around my knees to force myself to push out).

Foam roll your legs everyday, do TKEs before leg workouts, and wear sleeves to keep your knees warm. Also take a pain killer after workouts to zap any inflammation (I read a study a while ago that said people who did this actually healed faster – it not just for pain.)

I foam roll every day and often multiple times a day. If my knee starts hurting some direct work to the muscles on either side of the knee totally take the pain away.


#15

[quote]Xen Nova wrote:
thanks for scary the everloving cheese and crackers out of me lol. Considering how good i am with box squats I don’t know why i ever switched, i’m really regretting it now i can’t fucking train and it’s KILLING me.[/quote]

Ha. I mean this with all due respect, but good. I wasn’t smart enough to listen to my body, and now have to have surgery. I echo what another poster said, do not push through severe knee pain. You know your body. If something’s wrong, chill. I also agree with the pushing the knees out during squats assessment. I’m in a similar boat as you man, I’m doing this thing for strength and athleticism, and now, depending on if there’s a tear or not gotta chill for a bit. Don’t be a bonehead!


#16

might wanna check if you have tight quads and meniscus issues - tears/strains

squatting high bar all the way down will always bring out any meniscus problems


#17

[quote]CoolColJ wrote:
might wanna check if you have tight quads and meniscus issues - tears/strains

squatting high bar all the way down will always bring out any meniscus problems[/quote]

Please don’t make blanket statements like this. No, squatting with a high bar ATG will NOT always bring out meniscus problems. Please state some evidence if you feel otherwise.


#18

I said show up, not cause…


#19

Flat feet cause PF pain by pulling the knees inward. As others have suggested about pushing the knees out, this should help.

PF pain is caused by increased forces of the knee cap being pushed back into the knee joint proper. Evidence suggests that weak and/or tight quadriceps are likely culprits. ATG squatting can definitely increase these forces.

Can never go wrong with rest.


#20

[quote]danjo228 wrote:
Flat feet cause PF pain by pulling the knees inward. As others have suggested about pushing the knees out, this should help.

PF pain is caused by increased forces of the knee cap being pushed back into the knee joint proper. Evidence suggests that weak and/or tight quadriceps are likely culprits. ATG squatting can definitely increase these forces.[/quote]

There are actually lots of things that potentially cause patellofemoral pain and there is not one direct cause that one can pinpoint. Increased forces is definitely one potential factor that may lead to patellofemoral pain but there are others. I think more importantly is malalignment of the patella causing improper tracking on the femur more-so than increased forces. I have several references I can give in relation to this topic.

In addition, there are no studies that show there are increased patellofemoral joint reaction forces during ATG squats. I should know because I’m currently doing research for my PhD at Ohio State regarding patellofemoral joint reaction force in relation to squat depth and load. The best study we have to relate to is Salem and Powers (2001) that looked at collegiate female athletes and they found that patellofemoral joint reaction force and stress (force/patellofemoral contact area) were not statistically different between squat levels of 70 degrees, 90 degrees, and 110 degrees (about a parallel squat).